Frequently Asked Questions (FAQs)

 

What is assisted living?

Assisted living is a residential care option for individuals who typically can no longer live independently. It provides or coordinates services to meet residents’ individualized needs in ways that promote their independence and reflect their personal choices.

There are over 26 designations that states use to refer to what is commonly known as ‘assisted living’ and there is no single uniform definition of assisted living. The following is the definition that CCAL and a large number of national organizations support:

Assisted living is a state regulated and monitored residential long term care option. Assisted living provides or coordinates oversight and services to meet the residents’ individualized scheduled needs, based on the residents’ assessment and service plans and their unscheduled needs as they arise.

Service provisions must include but are not limited to:

  • 24-hour awake staff
  • Provision and oversight of personal and supportive services
  • Health related services (e.g. medication management services)
  • Social services
  • Recreational activities
  • Meals
  • Housekeeping and laundry
  • Transportation

A resident has the right to make choices and receive services in a manner that promotes dignity, autonomy, independence, and quality of life. These services are disclosed and agreed to in the contract between the provider and resident. Assisted living does not generally provide ongoing, 24-hour skilled nursing care.

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How does assisted living differ from a skilled care facility or a nursing home?

Assisted living is designed to respond to the needs of individuals who need assistance with activities of daily living such as bathing, dressing, and grooming, but who do not need 24-hour skilled nursing care. Some states require a nurse by regulation in an assisted living facility; others require round-the-clock nurse availability; others do not require nursing staff at all. Because the acuity needs of assisted living residents have increased over the past 10 years, CCAL recommends that a facility have a nurse on staff.

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What does assisted living look like?

The adage “if you have seen one assisted living facility, you have seen one assisted living facility” sums up the wide variability. There is no one type of model or design. It could be a high-rise building housing several hundred individuals, or it could be a small home with just a few. Living accommodations can include a full size apartment or a single room. In some facilities, services are limited to meal preparation, housekeeping, medication reminders, and minimal assistance. In others, more intensive services, including help with administering medications, on-site nurses, and regular assistance with daily activities such as bathing and dressing are available.

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How can I identify a good assisted living facility?

Regardless of the size or look of the facility, the foundation of a quality assisted living residence lies in its philosophy, practices, administration, and staff. You want to be sure that the administration’s philosophy and practices are truly resident-centered. You also want to know that they have well-trained, qualified direct care staff and have sufficient numbers of them to meet residents’ promised and unscheduled or emergency needs. The “feel” of the environment should be warm and inviting; with administrators, staff, residents, and family members interacting in a caring, respectful manner.

CCAL’s consumer publication “Choosing an Assisted Living Facility: Considerations for Making the Right Decision” details what to look for and what to ask when evaluating a facility.

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What types of services are offered?

There is wide variability in the scope of services and care provided by assisted living facilities. Many states set a threshold level of care need beyond which individuals can no longer stay in assisted living. Facilities can choose to provide any range of services up to this threshold. Some facilities, for example, may choose to discharge a resident that becomes incontinent.

Research shows that the major reason people leave assisted living is to receive a higher level of care. It is difficult to relocate, so you may want to consider a facility that offers a high range of care and services to begin with.

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Who lives in assisted living residences?

There are approximately 1 million assisted living residents living in over 36,000 facilities nationwide. The majority of individuals move into assisted living because of a significant change in health condition. Approximately two-thirds of residents come to assisted living from home. The rest come from hospitals, nursing homes, and other assisted living facilities.

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What are the costs/fees?

Approximately 90% of individuals pay for assisted living out-of-pocket or through other private funding. Monthly payments can range from $1,500 to $6,000+ depending on geographic location, unit size and services provided. Shared units, if available, generally cost less. The cost to live at Golden Gardens is exceptionally competitve and should be discussed with it's management.

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Is assisted living covered by Medicare, other government programs or private insurance?

Medicare, the federal health insurance program for older individuals, does not cover assisted living. Forty-one states currently use Medicaid waiver monies for some low-income individuals to support assisted living expenses; but the majority of assisted living is private pay.

Increasingly, long term care insurance policies include coverage for assisted living. There have been some payment issues from insurance companies for residents in states that do not have an appropriate assisted living licensing process. Be sure to check the status of your state.

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What happens if I run out of money?

As with any other consumer service, if you can not pay, then you can not stay. A small percent of facilities (generally non-profit-based) offer funding support if someone runs out of money, but this is not common.

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Do assisted living facilities serve younger people?

The majority of assisted living facilities are serving elderly people who can no longer live independently at home. However, some facilities do serve younger residents with physical or neurological disabilities. Smaller, more home-like facilities are often effective settings for younger people to develop a sense of “community among peers” rather than the large facilities that serve an older population. Regardless of the setting, facilities that serve younger disabled residents should provide age-appropriate practices, policies, and programs to reinforce residents’ sense of independence, privacy, and control over their own lives. Staff must be trained to effectively meet the specialized healthcare needs of these residents. The National Multiple Sclerosis Society has created Guidelines and Recommendations for Quality Care in Assisted Living that may serve as a useful resource for your initial exploration (www.nmss.org).

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How is assisted living regulated?

There are no federal regulations or uniform standards of operation for assisted living. Each state develops their assisted living regulations separately and differently. Some states began forming assisted living regulation as facilities began operation in their state. Other states lagged in this effort and only began addressing regulation in the past several years.

There is also great variability among states regarding the frequency of facility inspections ranging from once a year to none. CCAL recommends that states inspect assisted living facilities annually.

 

In California, the RCFEs (Retirement Care Facilities for the Elderly) are regulated by the State of California, Department of Social Services, Community Care Licensing Division. 

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What assisted living issues should I be aware of?

The U.S. General Accounting Office’s report (April 2004), “Assisted Living: Examples of State Efforts to Improve Consumer Protections,” identifies the following as continuing concerns in assisted living:

  • Consumer information about the facility – need for key information to assist consumers make informed decisions such as staffing levels and qualifications, costs and potential cost increases, and the circumstances that could lead to involuntary discharge from the facility
  • Consumer assistance with complaints against the provider – assisted living residents and their families sometimes need help pursuing a complaint against a provider, especially when faced with an involuntary discharge. The general public typically is not aware of or knowledgeable about long term care ombudsmen and what assistance they can provide
  • State regulation of assisted living – unlike nursing homes which are subject to federal regulations, assisted living facilities are regulated by states individually. State oversight and accountability vary widely.

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How do I choose an assisted living community that is right for my loved one?

The first step is to make an accurate and honest assessment of what your loved one’s physical, financial, mental and lifestyle needs are. If help is needed with this assessment, consider consulting a private geriatric care manager. These are trained professionals in the field of human services, experienced in assessment, and knowledgeable about assisted living choices in the area where they practice. Their knowledge can be an invaluable resource in helping make the right choice. Contact the National Association of Professional Geriatric Care Managers (www.caremanager.org for referrals).

The next step is for you and your loved one to visit a number of these facilities. Consider the proximity to those who will be visiting the most. The closer the facility, the more likely that visits will be more frequent. Ask lots of questions. Talk with residents about the facility. What do they like or dislike? Talk with staff. Are they friendly and knowledgeable? Ask to eat a meal there. Is the food good? Are there meal choices? Does the environment feel like a “good fit” for meeting your loved one’s physical and social-emotional needs; does it feel like a community of friends that you’d like to visit often.

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How can I compare different assisted living facilities to find the right one for my loved one?

Some states require the use of “disclosure statements” for assisted living facilities. These statements give consumers concise and consistent information that makes it easier to compare across different assisted living facilities regarding services, costs, policies, and reasons for discharge.

 

All facility search results are displayed in order of compatibility, based on a formula that matches the user’s search criteria with the information provided by the facility. The search results are intended to provide consumers with a starting point in locating a suitable facility.

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Is a facility contract (or sometimes called a Resident Agreement) important to consider?

Definitely. The contract is a legal document that states what services and arrangements you and the facility have agreed to, regardless of anything that was promoted and promised to you during tours, discussions and sales pitches. You should ensure that key information about costs, rights, care and services are detailed in the contract. CCAL recommends that prospective residents have an attorney (preferably an elderlaw attorney) review the contract before it is signed.

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What is a service plan?

A resident service plan is a blueprint for their care that describes their needs, likes and preferences and the specific manner in which this care will be delivered. Prepared thoroughly and thoughtfully, the service plan can help a resident achieve their highest level of function and quality of life. A well-developed service plan uses an interdisciplinary approach and includes the resident, the family if the resident wishes, the facility nurse and resident service coordinator, and may also include the activity and dining directors.

 

Many states require that assisted living facilities prepare service plans for each resident. Even if the state does not require it, a well run facility will use them. CCAL recommends that service plans be reevaluated every six months or anytime if there is a significant change in a resident’s health status including a hospitalization.

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What is a long term care ombudsman?

The federal government passed a law, the Olders American Act of 1978, that mandates states have long term care ombudsmen for residents in long term residential care including assisted living. These resident advocates are authorized and required under this law to respond to complaints and concerns made by or on behalf of long term care residents. Each state has a state long term care ombudsman and other local ombudsmen throughout the state. You can contact the Eldercare Locator number at (800) 677-1116 for the ombudsman nearest you.  The telephone number for the California State-Wide Ombudsman is:  800-232-4024.  The telephone number for the Ombudsman locally in San Diego County is 800-640-4661, or 858-560-2507.

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Can someone help me take my medication?

Many residents move into assisted living because they can no longer manage their medications. A resident’s ability to self-administer is determined during the admissions process. If a resident needs support, there are various levels of medication management. Some states have strict guidelines that require only a licensed nurse administer medications while other states allow an unlicensed caregiver to administer medications if they have successfully completed a state-approved course. Be sure to discuss what medication administration services the facility provides and the fees involved before signing any contract or resident agreement.

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Do I need an Advance Directive?

The assisted living facility should disclose its policies about implementing advance medical directives, including implementation of Do Not Resuscitate order (DNRs) and other medical directives that require limitations on delivery of medical services before you sign any contract or resident agreement.

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Will an assisted living community provide me with transportation to my doctor, hairdresser, etc.?

Typically, less than five percent (5%) of assisted living residents own or drive a car. Thus, transportation is an important resident consideration.

(Golden Gardens owns our own van which is always available whenever needed by residents. This service is included in the basic fee at Golden Gardens and is not an additional cost).

 

As in all other areas of assisted living, transportation availability varies by facility. Some facilities lease or own their own vans. Others make arrangements with community providers. Most facilities transport residents to recreational outings that are part of the planned activity program. Some will transport residents to doctors’ appointments, shopping, etc. Facilities also vary about charging extra for this service. Facilities should disclose details of their transportation services and charges to prospective residents in the Resident Agreement.

 

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Source:   Consumer Consortium on Assisted Living

                       California Department of Social Services